Hypertension the Silent Killer                        Epidemiology           Prof Faisal A Alnasir        FRCGP, MICGP, FF...
Hypertension•   Common•   Non Communicable disease•   Inevitable•   Preventable•   Serious complication                   ...
WHO       estimated that high blood pressurecauses   one   in   every eight          deaths,        makinghypertension the...
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Size of the problemWorld wide-1• In 2010, 1.2 billion people were expected to be suffering from  hypertension worldwide   ...
Size of the problem2-In the Eastern Mediterranean Region• The average prevalence of hypertension 26% and it affects  appro...
Size of the problemIn Bahrain                     National Non-communicable Diseases Risk Factors Survey 2007             ...
Size of the problemIn Bahrain                     National Non-communicable Diseases Risk Factors Survey 2007             ...
In Lebanon•23.1% are hypertensive•Prevalence increases with age•Occurs more in the less educated and unemployed•Prevalence...
Size of the problem:In Saudi Arabia.The prevalence range from 4% to 15%       .Abolfotouh MA et alIt may reach as high as ...
In Sudan of6-12y children:  4.9% were pre-hypertensive and  4.9% were hypertensive                                   Salm...
Size of the problemIt has been estimated that individuals who are  normotensive at the age 55 years have a                ...
Awareness of HypertensionAlthough the prevalence of high blood pressure is high,there is a low awareness rate (Up To 70% a...
Awareness of Hypertension                            Faisal Alnasir, 2004
Awareness of HypertensionIn Egypt only 37.5% of hypertensives were aware ofHaving it.In United States, Chile, and Cub, 32%...
Advantage of Controlling Hypertension•A 5-6 mmHg reduction in diastolic BP reduces stroke by 40%.                         ...
Economic Impact The economic burden of chronic NCDs can               be analyzed on two levels.•First, the effects of mac...
Economic ImpactDirect Cost:Including prescribing medicines, inpatient visits,outpatient visits, emergency room visits, off...
Economic Impact•Poor are disproportionately affected             •more vulnerable             •Prevalence 6 time more in u...
Economic Impact In Alkhobar the total direct cost of hypertensioncare for patients registered in the primary healthcare re...
PreventionPrimary prevention is the most cost-effectiveapproach    to   containing   the       emerginghypertension epidem...
PreventionIncidence of hypertension was reduced by 20% to50% if primary prevention were implemented                       ...
PreventionLife style Modification:•perform aerobic exercise•maintain a healthy body weight•follow a healthy diet•restrict ...
Recommended lifestyle modifications         Modification           Recommendation               Approximate systolic BP   ...
Life style Modification• Weight reduction  Every 1 kilogram of weight loss lower blood pressure by  1.6/1.1   mmHg        ...
Prevalence of overweight and obesity amongsome countries of the Eastern MediterraneanRegion (WHO.2004) Country            ...
In Bahrain             National Non-communicable Diseases Risk Factors Survey 2007
In Sudan of6-12y children:  45 (14.8%) were overweight; 32 (10.5%)  were obese                                   Salman Z...
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Life style Modification• Eating habits                                            30
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Life style Modification• Physical activity  Exercise lowers systolic and diastolic blood pressure  by 5-10 mmHg           ...
Life style Modification• Physical activity                                                                 33National Non-...
Life style Modification• Sodium moderationReducing dietary sodium intake to no more than 100 mEq/L g sodium or 6 g sodium ...
Life style Modification• Diabetes  (In Bahrain)                        National Non-communicable Diseases Risk Factors Sur...
Life style Modification• Diabetes  (In Bahrain)                                           36
Life style Modification• Tobacco  )In Bahrain)                                                                          37...
Lipids-
Life style Modification• Lipids  (In Bahrain)                                                                          39 ...
Life style Modification• Cocoa ingestion  100g/day of chocolate  drink reduces the systolic BP and  diastolic BP          ...
Change in Blood Pressure reduction              between cocoa & TeaBlood Pressure   Pooled Change (mm Hg) PCocoa Systolic ...
Change in Blood Pressure reduction            between cocoa & Tea“The magnitude of the hypotensive effects of cocoais in t...
Chocolate and Coronary Heart Disease: A Systematic ReviewThis article reviews current evidence on the effects of cocoa/cho...
Measurement of Blood Pressure         The "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12....
Measurement of Blood Pressure       The "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12.8%...
Measurement of Blood Pressure       The "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12.8%...
Hypertension Control      Very poor control of hypertension world wide         •In Egypt 23.9% were receiving treatment & ...
Measurement of Blood Pressure•Seated in a quiet room•Arm muscles relaxed•Cubital fossa at heart level•Avoid tight sleeves•...
ManagementGood management of hypertension is central to anystrategy formulated to control hypertension at thecommunity lev...
Management2 mmHg reduction in systolic blood pressureis likely to reduce the annual mortality fromstroke, coronary heart d...
ConclusionHypertension is a serious problem that couldbe called "the silent killer". Its prevalence isvery high especially...
ConclusionHypertension is a serious problem that couldbe called "the silent killer". Its prevalence isvery high especially...
ConclusionHypertension is a serious problem that couldbe called "the silent killer". Its prevalence isvery high especially...
Thank you        54
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Prof faisal hypertension presentation فيصل الناصر, د فيصل الناصر

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Prof faisal hypertension presentation فيصل الناصر, د فيصل الناصر

  1. 1. Hypertension the Silent Killer Epidemiology Prof Faisal A Alnasir FRCGP, MICGP, FFPH, PhDPresident, Family & Community Medicine Council Arab BoardChairman, Department of Family & Community Medicine Arabian Gulf University
  2. 2. Hypertension• Common• Non Communicable disease• Inevitable• Preventable• Serious complication 2
  3. 3. WHO estimated that high blood pressurecauses one in every eight deaths, makinghypertension the third leading killer in the world.Globally, there are one billion hypertensives andfour million people die annually as a direct resultof it. Hussein A. Gezairy Regional Director for the Eastern Mediterranean 3
  4. 4. 4
  5. 5. Size of the problemWorld wide-1• In 2010, 1.2 billion people were expected to be suffering from hypertension worldwide Sixth report of the Joint National Committee on prevention,1997• Expected to increase to 1.56 billion by 2025 International Society of Hypertension• Its prevalence from 20% to 30% of the adult population. Alwan A 1993• Incidence In USA between 14% to 40% in 35 to 64 years. WHO 2002• Prevalence in Canada 17.3%. Most patients had untreated hypertension (68.6%), and only 15.8% had blood pressure treated and controlled. 5
  6. 6. Size of the problem2-In the Eastern Mediterranean Region• The average prevalence of hypertension 26% and it affects approximately 125 million individuals.• Each year, there are several million new cases of hypertension and more of pre-hypertension Report on the regional consultation on hypertension UAE, 2003 6
  7. 7. Size of the problemIn Bahrain National Non-communicable Diseases Risk Factors Survey 2007 7
  8. 8. Size of the problemIn Bahrain National Non-communicable Diseases Risk Factors Survey 2007 8
  9. 9. In Lebanon•23.1% are hypertensive•Prevalence increases with age•Occurs more in the less educated and unemployed•Prevalence increases significantly with an increase in body mass index particularly in female patients•Only14.7% exercised daily R A Tohme, A R Jurjus, A Estephan 2005
  10. 10. Size of the problem:In Saudi Arabia.The prevalence range from 4% to 15% .Abolfotouh MA et alIt may reach as high as 20.4% for systolic hypertension and.25.9% for diastolic hypertension .Al-Nozha MM et al.In south-western 11.1% .Abolfotouh MA et alIn Jeddah, the hypertensive were 22.6%. Elkalifa Am et al.2011:In the UAEHypertension has become one of the leading public healthproblems 10
  11. 11. In Sudan of6-12y children: 4.9% were pre-hypertensive and 4.9% were hypertensive Salman Z, et al 2010
  12. 12. Size of the problemIt has been estimated that individuals who are normotensive at the age 55 years have a 90% lifetime risk for developing hypertension. EMR0 Technical Publications Blood pressure is under control in less than 20% of patients with hypertension in many countries A joint CINDI/EuroPharm Forum project WHO 12
  13. 13. Awareness of HypertensionAlthough the prevalence of high blood pressure is high,there is a low awareness rate (Up To 70% are unaware) Alwan A1993 13
  14. 14. Awareness of Hypertension Faisal Alnasir, 2004
  15. 15. Awareness of HypertensionIn Egypt only 37.5% of hypertensives were aware ofHaving it.In United States, Chile, and Cub, 32%, 37%, and 39%of the people were not aware. Pan American Health 15
  16. 16. Advantage of Controlling Hypertension•A 5-6 mmHg reduction in diastolic BP reduces stroke by 40%. Joint National Committee on Detection, 1992•lowering by 5-6mmHg can reduce mortality from cerebrovascular disease by 35%-40%, from ischemic heart disease by 15% 20% and reduction in all deaths from cardiovascular causes by 23%. Psaty, et al 1997• 3 mmHg decrease in systolic BP reduces annual mortality from stroke, coronary heart diseases and all other causes by 8%, 5% and 4%. Whelton PK, 1994•The chances of mortality from CVD in old hypertensive people when taking anti hypertensive medications is decreased by 34%. MacMahon, 1993 16
  17. 17. Economic Impact The economic burden of chronic NCDs can be analyzed on two levels.•First, the effects of macroeconomic policies on opportunities for prevention in different population groups •Second, the cost and overall efficiency of interventions must be evaluated in terms of effectiveness and health gains for the population at large. 17
  18. 18. Economic ImpactDirect Cost:Including prescribing medicines, inpatient visits,outpatient visits, emergency room visits, office-based medical provider visits, home healthvisits, and other medical expenses Sanjeev Balu, 2001 Indirect Cost: Productivity loss ($300 per eligible employee per year) absence & short term disability .Goetzel (2004), the only study in the U.S 18
  19. 19. Economic Impact•Poor are disproportionately affected •more vulnerable •Prevalence 6 time more in uneducated •Medication cost up to US$ 100 per month •further poverty•Cost to Health Services •USA total cost of CVD is 2% of the gross domestic product • direct medical costs estimated at nearly $55.0 billion for the year 2001 Sanjeev Balu, 2001 •Canada 21% of all diseases costs are due to CVD (US$12 billion/Year) direct cost is $3,072 per person per year, and indirect cost is $854 Guijing Wang,2008 19
  20. 20. Economic Impact In Alkhobar the total direct cost of hypertensioncare for patients registered in the primary healthcare represented 6.32% of the estimated cost of treating the expected number of patients. Al-Shahri 1998 20
  21. 21. PreventionPrimary prevention is the most cost-effectiveapproach to containing the emerginghypertension epidemic. Hussein AlGezairy Regional Director for WHO 21
  22. 22. PreventionIncidence of hypertension was reduced by 20% to50% if primary prevention were implemented Stamler 1991 For the developing countries prevention of hypertension should be the goal. 22
  23. 23. PreventionLife style Modification:•perform aerobic exercise•maintain a healthy body weight•follow a healthy diet•restrict salt intake•stress management•limit alcohol consumption 23
  24. 24. Recommended lifestyle modifications Modification Recommendation Approximate systolic BP reductionWeight reduction Maintenance of normal body weight 5–20 mmHg/10 kghealthy eating plan Consumption a diet rich in 8–14 mm Hg vegetables, fruits, and low-fat dairy products with a reduced content of saturated and total fatDietary sodium Reduction dietary sodium intake to 2–8 mmHg no more than 2.4 g sodiumPhysical activity Engagement in regular aerobic 4–9mmHg physical activity at least 30 minutes daily, most days of the 24 week
  25. 25. Life style Modification• Weight reduction Every 1 kilogram of weight loss lower blood pressure by 1.6/1.1 mmHg Khatib et al. EMR0 Technical Publications 25
  26. 26. Prevalence of overweight and obesity amongsome countries of the Eastern MediterraneanRegion (WHO.2004) Country Overweight/obesity (%) Males Females Saudi Arabia 64.0 70.0 Lebanon 60.0 53.0 Islamic Republic of Iran 57.0 67.7 Bahrain 56.4 79.0 Jordan 46.0 43.7 Egypt 43.8 41.0 Libyan Arab Jamahiriya 42.5 74.9 Oman 40.5 43.5 Morocco 37.2 21.7 United Arab Emirates 25.5 39.9 Tunisia 13.1 41.9 Kuwait 79 56 26
  27. 27. In Bahrain National Non-communicable Diseases Risk Factors Survey 2007
  28. 28. In Sudan of6-12y children: 45 (14.8%) were overweight; 32 (10.5%) were obese Salman Z et al 2010
  29. 29. 29
  30. 30. Life style Modification• Eating habits 30
  31. 31. 31
  32. 32. Life style Modification• Physical activity Exercise lowers systolic and diastolic blood pressure by 5-10 mmHg Arakawa 32
  33. 33. Life style Modification• Physical activity 33National Non-communicable Diseases Risk Factors Survey 2007
  34. 34. Life style Modification• Sodium moderationReducing dietary sodium intake to no more than 100 mEq/L g sodium or 6 g sodium chloride), reduces the blood 2.4 ). pressure by an average of 4–6 mmHg Khatib et al. EMR0 Technical Publications 34
  35. 35. Life style Modification• Diabetes (In Bahrain) National Non-communicable Diseases Risk Factors Survey 2007 35
  36. 36. Life style Modification• Diabetes (In Bahrain) 36
  37. 37. Life style Modification• Tobacco )In Bahrain) 37 National Non-communicable Diseases Risk Factors Survey 20
  38. 38. Lipids-
  39. 39. Life style Modification• Lipids (In Bahrain) 39 National Non-communicable Diseases Risk Factors Survey 20
  40. 40. Life style Modification• Cocoa ingestion 100g/day of chocolate drink reduces the systolic BP and diastolic BP Taubert et al 2007 40
  41. 41. Change in Blood Pressure reduction between cocoa & TeaBlood Pressure Pooled Change (mm Hg) PCocoa Systolic -4.7 .002 Diastolic -2.8 .006Tea Systolic 0.4 .63 Diastolic -0.6 .38 Taubert et al 2007 41
  42. 42. Change in Blood Pressure reduction between cocoa & Tea“The magnitude of the hypotensive effects of cocoais in the range that is usually achieved withmonotherapy of β-blockers or angiotensin-converting enzyme inhibitors” Taubert et al 2007 42
  43. 43. Chocolate and Coronary Heart Disease: A Systematic ReviewThis article reviews current evidence on the effects of cocoa/chocolate onclinical and subclinical coronary heart disease (CHD), CHD risk factors,and potential biologic mechanisms. The high content of polyphenols and flavonoids present in cocoa has been reported to play an important protective role in the development of CHD. Although studies have demonstrated beneficial effects of chocolate on endothelial function, blood pressure, serum lipids, insulin resistance, and platelet function, it is unclear whether chocolate consumption influences the risk of CHD. Khawaja O et al Current Atherosclerosis Reports, Volume 13 / September 2011
  44. 44. Measurement of Blood Pressure The "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12.8% inhypertensive patients. Marquez Contreras et al. 2006 44
  45. 45. Measurement of Blood Pressure The "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12.8% inhypertensive patients. Marquez Contreras et al. 2006 45
  46. 46. Measurement of Blood Pressure The "white-coat" effectPrevalence of white coat hypertensionwas 3.6% overall and 12.8% inhypertensive patients. Marquez Contreras et al. 2006 46
  47. 47. Hypertension Control Very poor control of hypertension world wide •In Egypt 23.9% were receiving treatment & 8% controlled Ibrahim et al. •In Canada 15.8% had blood pressure treated and controlled Petrella et al, 2007•In Saudi Arabia, 76 % were receiving treatment, but only 20% were found controlled Abolfotouh et al, 47
  48. 48. Measurement of Blood Pressure•Seated in a quiet room•Arm muscles relaxed•Cubital fossa at heart level•Avoid tight sleeves•Suitable size Cuff to be used•Repeat if BP > 140/90•Measurement on both arms•Mercury sphygmomanometers are most reliable Goodman and Gilmans1993 48
  49. 49. ManagementGood management of hypertension is central to anystrategy formulated to control hypertension at thecommunity level. Randomized trials of drugs thatlower and control blood pressure clearly show areduction in mortality and morbidity. Hussein A. Gezairy Regional Director for the Eastern Mediterranean 49
  50. 50. Management2 mmHg reduction in systolic blood pressureis likely to reduce the annual mortality fromstroke, coronary heart disease and all othercauses by 6%, 4% and 3%, respectively 50
  51. 51. ConclusionHypertension is a serious problem that couldbe called "the silent killer". Its prevalence isvery high especially in the GCC countries.Effective efforts ought to be taken in order toprevent, prevent, prevent, preventthen diagnose and treat it. 51
  52. 52. ConclusionHypertension is a serious problem that couldbe called "the silent killer". Its prevalence isvery high especially in the GCC countries.Effective efforts ought to be taken in order toprevent, prevent, prevent, preventthen diagnose and treat it. 52
  53. 53. ConclusionHypertension is a serious problem that couldbe called "the silent killer". Its prevalence isvery high especially in the GCC countries.Effective efforts ought to be taken in order toprevent, prevent, prevent, preventthen diagnose and treat it. 53
  54. 54. Thank you 54
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